1 / 19

U0 7-394

U0 7-394. #171408800 Cad Tx 15 years ago Recent  creatinine with mild proteinuria No RAS. DOB 28-2-74 Hydronephrosis and hydroureter identified in neonatal period 2 ° to posterior urethral valves. Right nephrectomy. Ileal conduit created. 1979: 1 st kidney transplant – early rejection

griffith-trujillo
Télécharger la présentation

U0 7-394

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. U07-394 #171408800 • Cad Tx 15 years ago • Recent  creatinine with mild proteinuria • No RAS

  2. DOB 28-2-74 • Hydronephrosis and hydroureter identified in neonatal period 2° to posterior urethral valves. Right nephrectomy. Ileal conduit created.

  3. 1979: 1st kidney transplant – early rejection • 1983: back on dialysis • 1984: 2nd transplant – early rejection with subsequent renal failure – not returned to dialysis! • 1986: 3rd transplant March • 1995: Biopsy IgA, creat 500 – PD started • 1997: October • 4th transplant • On prednisone, cellcept, tacrolimus • Base creatinine 130 • Persistant enterococus UTI • Creatinine unstable over several years • 2002 serum creatinine settled down about 160

  4. 2006: • slow progressive rise in creatinine to 250 with mild proteinuria and hypertension • MRA did not show RAS • Kidney biopsy done

  5. IF • IgG- Moderate linear GBM staining. • IgA- Moderate mesangial staining. • IgM- Mild mesangial staining with some granular extension to peripheral capillary loops. • C3- Moderate vascular staining. Mild mesangial staining. • C1q-Negative. • Kappa-Negative. • Lambda- Mild to moderate mesangial staining. • Fibrinogen- Mild to moderate interstitial staining. Mild to moderate mesangial staining. • Albumin- Moderate hyaline droplet change in tubular cytoplasm.

  6. IgG

  7. IgA

  8. IgM

  9. C3

  10. C3

  11. Lambda

  12. Fibrin

  13. Fibrin

  14. Albumin

  15. IF • C4d: Strong linear peritubular capillary staining

  16. C4d

  17. EM • Will be ready next week

  18. DiagnosisRenal Biopsy: • Chronic active Ab-mediated rejection with chronic transplant glomerulopathy • with a background of IgA nephropathy and anti-GBM Ab disease, both being documented by IF findings • C4d is positive and Ab-mediated rejection is likely to be the most important of the 3 disease entities present • Banff scores: • G0 CG2 I2 CI1 T1 CT1 V0 CV1 AH3 MM2 PTC3

  19. Comment • 3 concurrent diseases • Impossible to say with certainty which is the predominant disease process • Ab-mediated damage appears quite important: • aggregates of cells in PTC • chronic tg • C4d+ and may likely be the predominant process.

More Related